Effect of cognitive-behavioral couple therapy for PTSD: a randomized controlled trial.
Effect of cognitive-behavioral couple therapy for PTSD: a randomized controlled trial.
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DOI：
10.1001/jama.2012.9307
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发表时间：
2012-08-15
影响因子：
120.7
通讯作者：
Schnurr, Paula P.
中科院分区：
文献类型：
--
作者：
Monson, Candice M.;Fredman, Steffany J.;Macdonald, Alexandra;Pukay-Martin, Nicole D.;Resick, Patricia A.;Schnurr, Paula P.
创伤后应激障碍（PTSD）是一种与亲密关系问题相关的流行疾病，亲密关系因素已被证明会影响个体PTSD治疗结果。比较PTSD的认知行为联合治疗（一种向PTSD患者及其重要他人提供的手动夫妇治疗，以同时治疗PTSD症状并提高关系满意度）与等待名单条件。异性恋和同性伴侣（n=40对夫妇; n=80人）的随机对照试验，其中一方符合根据临床医生管理的PTSD量表确定的PTSD标准，于2008年至2012年在马萨诸塞州波士顿的退伍军人事务部门诊医院和加拿大安大略多伦多的大学研究中心进行。在基线、治疗中期（基线后中位数，8.00周[范围，1.71-20.43周]）和治疗后（基线后中位数，15.86周[范围，7.14-38.57周]），由盲法评估者收集PTSD症状、共病状况和关系满意度。还完成了非对照的3个月随访（基线后中位数38.21周[范围28.43-50.57周]）。夫妇被随机分配参加15个会话的认知行为联合治疗PTSD协议立即（n=20）或被放置在等待名单上的治疗（n=20）。临床医师评定的PTSD症状严重程度是主要结局，并采用临床医师管理的PTSD量表进行评估。亲密关系的满意度，评估与双适应量表，患者和合作伙伴的PTSD症状，共病症状是次要的结果。PTSD症状严重程度（评分范围，0-136）在夫妻治疗条件下比在等待名单条件下显著改善（平均变化差异，-23.21; 95%CI，-37.87至-8.55）。同样，患者的亲密关系满意度（评分范围，0-151）在夫妻治疗中比在等待名单条件下显著改善（平均变化差异，9.43; 95%CI，0.04-18.83）。在预测PTSD症状（t37.5=-3.09; P = 0.004）和患者报告的关系满意度（t68.5=2.00; P= 0.049）的多水平模型中，时间×条件相互作用效应显示，与等待名单相比，夫妻治疗具有优势。治疗效果在3个月随访时得以维持。在其中一方被诊断为患有PTSD的夫妇中，与等待治疗的列表相比，疾病特异性夫妇治疗导致PTSD症状严重程度和患者共病症状严重程度降低，患者关系满意度增加。clinicaltrials.gov标识符：NCT 00669981
Posttraumatic stress disorder (PTSD) is a prevalent condition associated with intimate relationship problems, and intimate relationship factors have been shown to affect individual PTSD treatment outcomes. To compare cognitive-behavioral conjoint therapy for PTSD (a manualized couple therapy delivered to patients with PTSD and their significant others to simultaneously treat PTSD symptoms and enhance relationship satisfaction) with a wait-list condition. Randomized controlled trial of heterosexual and same-sex couples (n=40 couples; n=80 individuals) in which one partner met criteria for PTSD according to the Clinician-Administered PTSD Scale, conducted from 2008 to 2012 in a Department of Veterans Affairs outpatient hospital setting in Boston, Massachusetts, and a university-based research center in Toronto, Ontario, Canada. Symptoms of PTSD, comorbid conditions, and relationship satisfaction were collected by blinded assessors at baseline, at mid treatment (median, 8.00 weeks [range, 1.71–20.43 weeks] after baseline), and at posttreatment (median, 15.86 weeks [range, 7.14–38.57 weeks] after baseline). An uncontrolled 3-month follow-up (median, 38.21 weeks [range, 28.43–50.57 weeks] after baseline) was also completed. Couples were randomly assigned to take part in the 15-session cognitive-behavioral conjoint therapy for PTSD protocol immediately (n=20) or were placed on a wait list for the therapy (n=20). Clinician-rated PTSD symptom severity was the primary outcome and was assessed with the Clinician-Administered PTSD Scale. Intimate relationship satisfaction, assessed with the Dyadic Adjustment Scale, patient- and partner-rated PTSD symptoms, and comorbid symptoms were secondary outcomes. PTSD symptom severity (score range, 0–136) was significantly more improved in the couple therapy condition than in the wait-list condition (mean change difference, −23.21; 95% CI, −37.87 to −8.55). Similarly, patients’ intimate relationship satisfaction (score range, 0–151) was significantly more improved in couple therapy than in the wait-list condition (mean change difference, 9.43; 95% CI, 0.04–18.83). The time×condition interaction effect in the multilevel model predicting PTSD symptoms (t37.5=−3.09; P =.004) and patient-reported relationship satisfaction (t68.5=2.00; P=.049) revealed superiority of the couple therapy compared with the wait list. Treatment effects were maintained at 3-month follow-up. Among couples in which one partner was diagnosed as having PTSD, a disorder-specific couple therapy, compared with a wait list for the therapy, resulted in decreased PTSD symptom severity and patient comorbid symptom severity and increased patient relationship satisfaction. clinicaltrials.gov Identifier: NCT00669981
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影响因子：
5.9
作者：
Taft, Casey T.;Watkins, Laura E.;Monson, Candice M.
通讯作者：
Monson, Candice M.
影响因子：
5.9
作者：
JACOBSON, NS;TRUAX, P
通讯作者：
TRUAX, P
影响因子：
10.3
作者：
Caska, Catherine M.;Renshaw, Keith D.
通讯作者：
Renshaw, Keith D.
影响因子：
2.2
作者：
MacIntosh, Heather B.;Johnson, Susan
通讯作者：
Johnson, Susan
DOI：
10.2307/350547
发表时间：
1976-01-01
期刊：
JOURNAL OF MARRIAGE AND THE FAMILY
影响因子：
--
作者：
SPANIER, GB
通讯作者：
SPANIER, GB